Provider Demographics
NPI:1740324292
Name:STALL, ALEC C (MD, MPH)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:C
Last Name:STALL
Suffix:
Gender:M
Credentials:MD, MPH
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:13535 NEMOURS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2019-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN8350207XP3100X
FLME136094207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100234700Medicaid